A Systematic Review of the Usage of Rotigotine During Early and Advanced Stage Parkinson's.

Parkinson's disease (PD) is a prevalent neurodegenerative disorder that occurs in old age due to a decrease in dopamine, which causes nerve cell destruction. This disease is difficult to diagnose since its symptoms are similar to those of the aging process. Those with PD have impaired motor control and function, dyskinesia, and tremors. To treat PD, drugs that enhance the amount of dopamine given to the brain are administered to alleviate symptoms. This inquiry examines the prescription of rotigotine to achieve this objective. The primary objective of this review is to examine the usage of rotigotine in both the late and early stages of PD. The statistical model utilized in the review found that there was not a significant difference in the dosage of rotigotine prescribed to late and early-stage PD patients, however, there were some confounding variables that may have skewed this result; therefore, further research is necessary to validate or nullify this hypothesis.

Inflammatory Cloacogenic Polyp: A Rare Benign Colorectal Polyp.

Inflammatory cloacogenic polyps are a rare kind of benign polyp that is located in the anal transitional zone and rectum. We report the case of a 53-year-old male who underwent a diagnostic colonoscopy for a positive fecal immunochemical test. Two 7 mm polyps were found in the rectum with a pathological diagnosis of inflammatory cloacogenic polyp. The polyp was endoscopically resected. These polyps are associated with chronic inflammatory conditions such as Crohn's disease and colorectal tumors. Because of malignant transformation potential, inflammatory cloacogenic polyps are endoscopically removed.

Infusion Therapies for Parkinson's Disease.

PURPOSE OF REVIEW: Advanced Parkinson's disease (APD) is marked by significant motor and non-motor complications affecting the patient's quality of life. Optimization of standard oral therapies (SOT) at some point fails to provide adequate relief. Among the available device-aided therapies, infusion therapies (IT) work on the rationale that continuous striatal dopaminergic stimulation can significantly reduce the motor fluctuations and smoothen the treatment response. This review serves to familiarize readers with available IT for APD with a focus on motor and non-motor effects, and safety. RECENT FINDINGS: Several recent longitudinal studies have demonstrated a reduction in OFF and an equivalent increase in ON time with the use of levodopa-carbidopa intestinal gel infusion (LCIG). Additionally, the benefit is noted on dyskinesia and non-motor symptoms. Similarly, backed by long-term clinical experience and open-label studies, a recent double-blind trial validates the efficacy of continuous subcutaneous apomorphine infusion (CSAI). Both IT are accompanied by a high rate of mild to moderate adverse events (AE) that can influence patient selection and clinical utility. While device and procedure-related AE are common for LCIG, infusion site reactions dominate the CSAI AE. IT are a viable and superior alternative for APD over SOT. Both therapies provide meaningful improvement of the motor fluctuations with a positive impact on the quality of life.

A Novel SGCE Nonsense Variant Associated With Marked Intrafamilial Variability in a Turkish Family With Myoclonus-Dystonia.

BACKGROUND: Myoclonus-Dystonia syndrome (M-D) is an autosomal-dominant movement disorder related to SGCE gene pathogenic variants. Although there can be observed variability in clinical findings, here we describe intrafamilial variability in a Turkish family with a novel nonsense SGCE pathogenic variant. METHODS: A family with variable clinical symptoms resembling M-D were referred to our clinic. After preliminary diagnosis, patients were tested for mutations in the SGCE gene by Sanger sequencing. RESULTS: Novel pathogenic heterozygous nonsense mutation in exon 3, c.272T>G; p.Leu91* (NM_003919.2) were observed in affected family members. CONCLUSION: Intrafamilial clinical variability, despite the same pathogenic variant described in this work, suggests that there are regulatory factors, epigenetic or environmental modifiers, which are the subject of a matter for future studies.

Feasibility and safety of lumbar puncture in the Parkinson's disease research participants: Parkinson's Progression Marker Initiative (PPMI).

OBJECTIVE: To determine the feasibility, safety and tolerability of lumbar punctures (LPs) in research participants with early Parkinson disease (PD), subjects without evidence of dopaminergic deficiency (SWEDDs) and healthy volunteers (HC). BACKGROUND: Cerebrospinal fluid (CSF) analysis is becoming an essential part of the biomarkers discovery effort in PD with still limited data on safety and feasibility of serial LPs in PD participants. DESIGN/METHODS: Parkinson's Progression Marker Initiative (PPMI) is a longitudinal observation study designed to identify PD progression biomarkers. All PPMI participants undergo LP at baseline, 6, 12 months and yearly thereafter. CSF collection is performed by a trained investigator using predominantly atraumatic needles. Adverse events (AEs) are monitored by phone one week after LP completion. We analyzed safety data from baseline LPs. RESULTS: PPMI enrolled 683 participants (423 PD/196 HC/64 SWEDDs) from 23 study sites. CSF was collected at baseline in 97.5% of participants, of whom 5.4% underwent collection under fluoroscopy. 23% participants reported any related AEs, 68% of all AE were mild while 5.6% were severe. The most common AEs were headaches (13%) and low back pain (6.5%) and both occurred more commonly in HC and SWEDDs compared to PD participants. Factors associated with higher incidence of AEs across the cohorts included female gender, younger age and use of traumatic needles with larger diameter. AEs largely did not impact compliance with the future LPs. CONCLUSIONS: LPs are safe and feasible in PD research participants. Specific LP techniques (needle type and gauge) may reduce the overall incidence of AEs.

Universal significance of the principle of Samanya and Vishesha beyond Ayurveda.

There is a fundamental principle in Ayurveda, known as the principle of Samanya (similarity) and Vishesha (difference). While the principle was essentially propounded in the context of yuktivyapashraya (rational medicine) in Ayurveda, here we would like to argue that it has universal applicability in Ayurveda and beyond, across systems and domains of knowledge, including science, technology and humanities, as well as scientific, experiential and traditional knowledge systems. Taking examples of some of the most well-known problems of ecology, economy and society, we demonstrated the universal significance of the principle of Samanya and Vishesha. To illustrate our argument, we have discussed three brief cases, as diverse as family, climate governance, and poverty reduction, and discussed in the light of the Samanya and Vishesha. Evidently, these issues also have larger relevance to public health. Bringing an Ayurveda concept out from its premises is a new order of thinking. The path-breaking insights that were provided, have important implication for deciphering other basic principles of Ayurveda from the perspective of their wider applicability, and thus their robustness. We have indicated a way forward for future research in Ayurveda to develop knowledge-base for evidence-based clinical practice in contemporary society.

Familial pseudoxanthoma elasticum associated with multiple comedones.

Pseudoxanthoma elasticum (PXE) is an autosomal recessive disorder characterized by atypical elastic fibers that causes connective tissue abnormalities of the skin, eyes, and heart, among other organs. The disorder is rare, with a classic presentation of yellow-orange cobblestone-like papules on flexural areas, lax skin, ocular degeneration, and moribund vasculature in multiple organs. There is wide variability in the presentation of the affected organs [1]. We present two sisters with classic cutaneous findings of PXE with the additional unusual findings of numerous open comedones on the neck. To our knowledge, this is the first report of numerous open comedones in familial PXE.

The use of facial modeling and analysis to objectively quantify facial redness.

BACKGROUND: The reproducible evaluation of facial redness is critical to the assessment of erythematotelangiectatic rosacea. Assessments have typically focused on the use of photography with the use of semi-quantitative grading scales based on evaluator rating. However, few studies have utilized computer-based algorithms to evaluate facial redness. AIM: The purpose of this clinical study was to assess whether there is correlation between clinical grading of facial redness to the assessment of a quantitative computer-based facial modeling and measurement. MATERIAL AND METHODS: In this prospective study, a set of high-resolution facial photographs and cross-polarized subsurface photographs for erythema detection were obtained for 31 study participants. A computer algorithm was then utilized to detect and quantify facial redness in the photographs and compare this to semi-quantitative evaluator-based grading for facial redness. RESULTS: There was a strong correlation between computer-based cross-polarized subsurface erythema quantification and clinical grading for redness intensity (Clinical Erythema Assessment), redness distribution, and overall redness severity (Modified Clinical Erythema Assessment). CONCLUSION: Overall, facial redness measurements by facial imaging and computer analysis correlated well to clinical grading scales for both redness intensity and distribution. Future studies should incorporate facial modeling and analysis tools for assessments in clinical studies to introduce greater objectivity and quantitative analysis in facial erythema-based analyses.

The association of the sebum excretion rate with melasma, erythematotelangiectatic rosacea, and rhytides.

BACKGROUND: Rosacea and melasma are two common skin conditions in dermatology. Both conditions have a predilection for the centrofacial region where the sebaceous gland density is the highest. However it is not known if sebaceous function has an association with these conditions. AIMS AND OBJECTIVES: We aimed to assess the relationship between facial glabellar wrinkle severity and facial sebum excretion rate for individuals with rosacea, melasma, both conditions, and in those with rhytides. Secondly, the purpose of this study was to utilize high resolution 3D facial modeling and measurement technology to obtain information regarding glabellar rhytid count and severity. MATERIALS AND METHODS: A total of 21 subjects participated in the study. Subjects were divided into four groups based on facial features: rosacea-only, melasma-only, rosacea and melasma, rhytides-only. A high resolution facial photograph was taken followed by measurement of facial sebum excretion rate (SER). RESULTS: The SER was found to decline with age and with the presence of melasma. The SER negatively correlated with increasing Wrinkle Severity Rating Scale. Through the use of 3D facial modeling and skin analysis technology, we found a positive correlation between clinically based grading scores and computer generated glabellar rhytid count and severity. CONCLUSION: Continuing research with facial modeling and measurement systems will allow for development of more objective facial assessments. Future studies need to assess the role of technology in stratifying the severity and subtypes of rosacea and melasma. Furthermore, the role of sebaceous regulation may have important implications in photoaging.

Necrolytic acral erythema masquerading as cellulitis.

Necrolytic acral erythema (NAE) is a rare cutaneous sign of hepatitis C virus infection and has recently been linked to zinc deficiency. It presents as well-demarcated erythematous plaques in a sandal-like distribution on the dorsal feet with psoriasiform epidermal hyperplasia on histology. Our patient reported a 9-month history of progressive bilateral lower extremity erythema, swelling, erosions, and nail dystrophy that failed to improve despite multiple courses of antibiotics for presumed lower extremity cellulitis. Serum studies revealed zinc deficiency. This case supports the association of NAE with both HCV infection and zinc deficiency and highlights the pitfalls in the diagnosis of chronic unrecognized NAE. Suspected cases of NAE should prompt evaluation for underlying HCV and zinc deficiency to avoid treatment delay and associated complications.

Disseminated histoplasmosis presenting as panniculitis in two immunosuppressed patients.

We report two patients with polymyositis on immunosuppressive drugs and biologics with subsequent development of disseminated histoplasmosis presenting as panniculitis.